Quantitative analysis of whole-tumor Gd enhancement histograms predicts malignant transformation in low-grade gliomas

Paul S Tofts, Christopher E Benton, Rimona S Weil, Daniel J Tozer, Daniel R Altmann, H Rolf Jäger, Adam D Waldman, Jeremy H Rees

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

PURPOSE: To quantify subtle gadolinium (Gd) enhancement (signal increase) in whole-tumor histograms and optimize their ability to predict subsequent malignant transformation in low-grade gliomas (LGGs).

MATERIALS AND METHODS: We analyzed histograms from 21 adult subjects with LGGs (eight nontransformers and 13 transformers) who had been imaged every six months for periods of two to five years. Before transformation these tumors were reported as radiologically non-enhancing. Imaging included a T(1)-weighted volume sequence before and after a double dose of Gd-DTPA contrast agent. Image data sets were spatially registered and subtracted to obtain maps of percent enhancement (%E). Tumor outlines were defined on fluid-attenuated inversion recovery (FLAIR) images, and the volumes were calculated. Histogram tails were analyzed to obtain the volume (mL) of subtly enhancing tissue (%E > 10%).

RESULTS: Baseline enhancing volumes were higher for Ts than for NTs (P < 0.005). Kaplan-Meier survival curves for a threshold of 4 mL showed clear differences at five years (P < 0.04). Pretransformation examinations predicted transformation (corrected threshold = 3.0 mL, P = 0.011).

CONCLUSION: Clear histogram differences at presentation suggest that the process of transformation starts very early. It is now possible to identify individuals at high risk for transformation at baseline by quantifying the volume of subtly enhancing tumor tissue, and such findings could have an impact on patient management.

Original languageEnglish
Pages (from-to)208-14
Number of pages7
JournalJournal of Magnetic Resonance Imaging
Issue number1
Publication statusPublished - 21 Dec 2006

Keywords / Materials (for Non-textual outputs)

  • Adult
  • Aged
  • Brain Neoplasms
  • Cell Transformation, Neoplastic
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Glioma
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pilot Projects
  • Journal Article


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